2nd February 2018, Volume 131 Number 1469

Romosozumab or alendronate for fracture prevention in women with osteoporosis

Romosozumab is a monoclonal antibody that binds to and inhibits sclerostin, increases bone formation and decreases bone resorption.

Over 4,000 postmenopausal women with osteoporosis and a high risk of fracture were enrolled in this study. They were randomly assigned in a 1:1 ratio to receive monthly subcutaneous romosozumab (210mg) or weekly oral alendronate (70mg) in a blinded fashion for 12 months, followed by open-label alendronate in both groups. The primary end points were the incidence of vertebral and non-vertebral fractures at 24 months. The researchers report a 48% lower risk of new vertebral fractures and a 19% lower risk of non-vertebral fractures in those receiving the combined treatments. Adverse effects were balanced between the two groups.

It was concluded that in postmenopausal women with osteoporosis who were at high risk for fracture, romosozumab treatment for 12 months followed by alendronate resulted in a significantly lower risk of fracture than alendronate alone.

N Engl J Med 2017; 377:1417–27

Effect of azithromycin on asthma exacerbations and quality of life in adults with persistent uncontrolled asthma

Adults with uncontrolled persistent asthma despite maintenance treatment require additional therapy. Since macrolide antibiotics can be used to treat persistent asthma, these researchers aimed to assess the efficacy and safety of oral azithromycin as add-on therapy in patients with uncontrolled persistent asthma on medium-to-high dose inhaled corticosteroids plus a long-acting broncholidator.

Four hundred and twenty appropriate patients were randomised to receive 500mg of azithromycin or placebo three times per week for 48 weeks. Those in the azithromycin cohort were reported to have improved quality of life and fewer asthma exacerbations. They also had fewer respiratory infections. The treatment was well tolerated.

The study was noted in an editorial with interest. These commentators suggest that a future trial using a non-antibiotic macrolide would be warranted.

Lancet 2017; 390:659–68 & 629–630

Benzodiazepines and risk of all-cause mortality in adults

What is the risk of all-cause mortality associated with benzodiazepine initiation in adults?

This question is reviewed in this retrospective cohort study. The researchers examined data concerning patients who were treated with benzodiazepines and those who were not so treated. The study involved over 1.25 million patients between 2004 and 2013.

This study found either no increase or at most a minor increase in risk of all-cause mortality associated with benzodiazepine initiation. If a detrimental effect exists, it is likely to be much smaller than previously reported and to have uncertain clinical relevance.

BMJ 2017; 358:j2941